腹腔镜胃袖状切除术后物理治疗对肥胖患者抗凝效果的研究

Use of anticoagulant mechanical methods after laparoscopic sleeve gastrectomy for obese patients

目的探讨腹腔镜胃袖状切除术后物理治疗对肥胖患者的抗凝疗效。方法本研究为前瞻性观察性研究。54例肥胖患者纳入本研究,所有患者均在术后给予抗血栓物理治疗,记录患者术前BMI及手术相关指标,术前、气腹结束时(术后0 h)及术后24 h测定凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、D-二聚体。结果54例患者均成功实施了手术,无术后严重并发症。术前患者平均BMI为(43.49±8.29)kg/m2。术后连续3 d应用抗血栓压力泵治疗。术后0、24 h凝血酶原时间比术前延长[(12.4±1.2)s、(12.4±0.8)s比(11.2±0.8)s,P=0、0];术后0、24 h活化部分凝血活酶时间较术前缩短[(29.7±3.6)s、(29.0±3.1)s比(31.2±3.3)s,P=0.020、0.001];术后0、24 h D-二聚体较术前升高[(213±143)ng/ml、(445±237)ng/ml比(85±108)ng/ml,P=0、0]。术后随访1个月,无血栓相关的手术并发症。结论肥胖患者行腹腔镜胃袖状切除术后及时采取物理抗凝治疗可预防血栓形成。

Objective To investigate anticoagulant effects of mechanical methods in obese patients undergoing laparoscopic sleeve gastrectomy(LSG).Methods In this prospective study,54 obese patients receiving LSG were enrolled.All patients were given post-op mechanical methods for thrombogenic interventions.BMI and the operation-related factors were recorded.Venous blood specimens were taken from each patient before surgery,at the end of pneumoperitoneum(i.e.,0 h after surgery),at 24 hours after surgery for prothrombin time(PT)and activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer(D-D).Results All 54 obese patients successfully underwent LSG.No severe complications were observed.Before operation,the mean BMI was(43.49±8.29)kg/m2.DVT-2600 device was applied in all patients for 3 consecutive days after surgery.The PT values increased at 0 h,24 h after surgery[(12.4±1.2)s,(12.4±0.8)s vs.(11.2±0.8)s,P=0,0].The APTT values at 0 h,24 h after surgery decreased[(29.7±3.6)s,(29.0±3.1)s vs.(31.2±3.3)s,P=0.020,0.001].However,the D-D values increased at 0 h,24 h after operation[(213±143)ng/ml,(445±237)ng/ml vs.(85±108)ng/ml,P=0,0].All patients were followed up for 1 month,and no thrombosis-related complications were observed.Conclusion Mechanical methods for obese patients after LSG can help decrease the risk of deep venous thrombosis.